20170821 Staples17082104
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL15G5WRG Wisconsin Motor Vehicle
Crash Report
Secondary
CrashAmendedCrash Type
DT4000 (Standard Crash)Reportable
TagsSchool Bus Related
NoActive School ZoneGovernment
Property
Trailer or TowedWork ZoneLane ClosureHit and RunOn Emergency
Total Killed
00
Total Injured
01
Total Units
01
Time Notified
04:37 AM
Date Notified
08/21/2017
Time Arrived
04:37 AM
Date Arrived
08/21/2017
Crash Time
04:00 AM
Crash Date
08/21/2017
Investigating Officer/Deputy
SERGEANT NICK ALMOGHRABI
Agency Crash Number
17082104
Primary Crash Document #Document Number Override
6V
L
1
5
G
5
W
R
G
Additional InformationPhotos, Other Documents
Photos BySGT ALMOGHRABI/DEPUTY
JENSEN
Reconstruction ByDiagram
Description
Narrative: I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
R/O LOCATED THIS VEHICLE PARKED AT PINEWOOD REALTY 15437 CTH B IN THE CITY OF HAYWARD ON 08/21/17 AT 0437 WITH THE HAZARDS ON. UPON CHECKING ON IT, R/O OBSERVED THE ENTIRE DRIVER'S SIDE OF THE TRUCK WAS SEVERELY DAMAGED WITH AIR BAG DEPLOYMENT. R/O
FOUND THE REGISTERED OWNER STANDING OUTSIDE THE PASSENGER DOOR LEANING INTO THE VEHICLE. R/O FURTHER OBSERVED BLOOD ON
THE OPERATOR AND THE AIRBAGS. UPON GETTING HIM TO STEP OUT, R/O DETECTED A VERY STRONG ODOR OF INTOXICANTS COMING FROM HIS
PERSON, SLURRED SPEECH, AND GLASSY EYES. THE OPERATOR WOULDN'T ADMIT TO WHERE THE CRASH OCCURRED AND STATED HE DIDN'T
KNOW ANYTHING ABOUT IT. THE OPERATOR WAS TAKEN BY EMS TO HAMH WHERE HE AGREED TO AN EVIDENTIARY CHEMICAL TEST OF HIS
BLOOD FOR OWI 1ST. R/O WAS ADVISED BY DEPUTY JENSEN THAT ON THE AFTERNOON OF 8/21 HE WAS DISPATCHED TO CTH B EAST OF CTH W IN THE TOWNSHIP OF WINTER FOR A POWER POLE THAT WAS HIT BY A VEHICLE. EVIDENCE AT THE SCENE IN INCLUDING PART OF THE DRIVER'S
DOOR HANDLE AND MIRROR (BOTH MISSING ON TRUCK) AND GREEN PAINT TRANSFER WERE PRESENT. THE ITEMS HAVE BEEN MATCHED TO THE
VEHICLE AT THE TOW COMPANY'S IMPOUND LOT. THE POWER POLE OWNED BY NORTH CENTRAL POWER WAS BROKE OFF APPROX 8 FEET FROM
THE GROUND HOWEVER HAD NOT DISRUPTED SERVICE.
Crash Time 04:00 AM
Crash Date 08/21/2017Wisconsin Motor Vehicle Crash
Form DT4000 1 of 5
This report does not include any CJIS data.
17082104
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL15G5WRG Wisconsin Motor Vehicle
Crash Report
Structure Type
Y Coordinate
5090576.5
X Coordinate
189112.09375
Longitude
-91.007736397
Latitude
45.898429256
ON CTHB
0.94 MI E
OF BARKER LAKE RD
IN THE TOWN OF WINTER
IN SAWYER COUNTY
Location
Special StudyAccess Control
No Control
Tribal Land
Crash Classification - Jurisdiction
No Special Jurisdiction
Crash Classification - Location
Public Property
Relation To Trafficway
Trafficway - Not On Road
Animal Type
Weather Condition(s)
Clear
Environment Factor(s)
None
Roadway Factor(s)
None
Road Surface Condition(s)
Dry
Light Condition
Dark/Unlit
Manner of Collision
No Collision W/Vehicle In Transport
First Harmful Event Location
Shoulder Left
First Harmful Event
Utility Pole
Crash Scene
Intersection Type
Not an Intersection
Junction Location
Non-Junction
Within Interchange Area
NO
Reporting Threshold
No
Truck Bus or HazMat
No
Road Grade
Level
Road Curvature
Curve Right
Surface Type
Blacktop (Bituminous)
Traffic Control Inoperative/Missing
NO
Traffic Control
No Control
Traffic Way
Two-Way, Not Divided
Emergency Motor Vehicle UseNot ApplicableSpecial FunctionNo Special FunctionMost Harmful Event: Collision With
Utility Pole
Total Lanes
2
Speed Limit
55Pre CrashTire
Mark
Direction Of Travel
Westbound
Insurance?
UNKNOWN
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
2
Train/Bus # InjuredTotal Occs
1
Operating As EndorsementsVehicle Type
Utility Truck/Pickup Truck
Unit Type
Truck
Vehicle Operating As Classification
D CLASS
Unit Status
Hit and Run
UN
I
T
01
Unit Summary
Extent Of Damage
Functional Damage
Vehicle Damage
7--Left Rear Corner, 8--Left Side Rear, 9--Left Side Middle, 10--Left Side Front,
11--Left Front Corner
Initial Contact Point
11--Left Front Corner
Bus UseNot A BusBody Style
TK - TRUCK
Color
GRN - Green
Model
SILVERADO
Year
2015
Make
CHEVROLET
Vehicle Identification Number
5937
Country of Issuance
UNITED STATES
St
WI
Plate Type
LTK - Light Truck
License Plate Number
LZ5418
VE
H
I
C
L
E
UN
I
T
01
Vehicle
Crash Time 04:00 AM
Crash Date 08/21/2017Wisconsin Motor Vehicle Crash
Form DT4000 2 of 5
This report does not include any CJIS data.
17082104
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL15G5WRG Wisconsin Motor Vehicle
Crash Report
Driver DistractionsUnknown If Distracted
Driver Actions
Unknown
Driver Prior Action Other
Vehicle Factors
Unknown
What Driver Was Doing
Unknown
Vehicle Removed By
ROADRUNNER TOWING
Towed Due To Damage
Towed But Not Due To Disabling Damage
VE
H
I
C
L
E
UN
I
T
01
Address
HAYWARD, WI 54843 , US
IndividualGERALD WILLIAM STAPLES01
VE
H
I
C
L
E
OW
N
E
R
Vehicle Owner
Sequence Of Events
EventDitch01
EventUtility Pole02
Event
03
Event
04
Crash Time 04:00 AM
Crash Date 08/21/2017Wisconsin Motor Vehicle Crash
Form DT4000 3 of 5
This report does not include any CJIS data.
17082104
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL15G5WRG Wisconsin Motor Vehicle
Crash Report
Individual Condition
Not Observed
Drug Type
Drug Test ResultsDrug Test TypeDrug Test GivenTest Not Given
Alcohol Test ResultsAlcohol Test TypeAlcohol Test Given
Test Not Given
Suspected Drug UseSuspected Alcohol Use
Action Other
IN
D
I
V
I
D
U
A
L
UN
I
T
Action
To/From SchoolLocationPrior ActionStriking Unit #
00
1
01
Time of DeathDate of DeathHospital
HAYWARD AREA MEMORIAL HOSPITAL
EMS Run #
17082111401
EMS Agency Identifier
6000954
Medical Transport
EMS Ground
Trapped/Extricated
Not Applicable
Ejection Path
Not Ejected/Not Applicable
Ejected
Not Applicable
Airbag
Not Applicable
Injury Severity
Suspected Minor Injury
IN
D
I
V
I
D
U
A
L
UN
I
T
Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
1--Front Seat-Left Side (Driver/Motorcycle/Bicycl
00
1
Safety Equipment
None Used - Vehicle Occupant
On Duty Crash
01
ber
State: Wisconsin Country: UNITED STATES
Address
HAYWARD, WI 54843 , US
RaceINDIANDate of Birth
10/24/1
Sex
Male
Citations Issued
2
DriverGERALD WILLIAM STAPLES
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Violations
DescriptionOPERATING WHILE UNDER THE INFLUENCESeq Num002Statute Number346.63(1)(a)Issue To?
001
UTC Number
AE53901001
DescriptionHIT AND RUN-PROPERTY ADJACENT TO HIGHWAYSeq Num001Statute Number346.69Issue To?
001
UTC Number
AE53901102
AddressOrganization/Company
Property Owner
Crash Time 04:00 AM
Crash Date 08/21/2017Wisconsin Motor Vehicle Crash
Form DT4000 4 of 5
This report does not include any CJIS data.
17082104
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL15G5WRG Wisconsin Motor Vehicle
Crash Report
3661N CLARK STREET
RADISSON, WI 54867 , US
NORTH CENTRAL POWER COMPANY INC
(715) 945-2630
PR
O
P
OW
N
E
R
01
Fixed Objects Struck
Damage Tag NumberStruck Object
Utility Pole
Striking Unit
0101
Crash Time 04:00 AM
Crash Date 08/21/2017Wisconsin Motor Vehicle Crash
Form DT4000 5 of 5
This report does not include any CJIS data.